Provider Demographics
NPI:1992745608
Name:SELIGSOHN, BRUCE (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:SELIGSOHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BRUCE
Other - Middle Name:
Other - Last Name:SELIGSOHN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:26302 LA PAZ RD
Mailing Address - Street 2:STE 211
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5328
Mailing Address - Country:US
Mailing Address - Phone:949-588-8775
Mailing Address - Fax:949-588-9005
Practice Address - Street 1:27001 LA PAZ RD
Practice Address - Street 2:#294
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5502
Practice Address - Country:US
Practice Address - Phone:949-588-8775
Practice Address - Fax:949-588-9005
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62830207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D20849Medicare UPIN